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If we don't protect the aged, we will suffer when old

Fri, Oct 30, 2009, 00:00

OPINION:The ‘aged’ is not an abstract concept – they are you and me one day. They need better care, writes DES O'NEILL

IN THE Grimm Brothers tale The Old Man and His Grandson, an old man who can no longer eat tidily is banished by his adult children from the family table to the corner behind the stove. They treat him shabbily, but are chastened by the sight of their own four-year-old child collecting bits of wood to make a trough for them to eat from when they are old. They look at each other, begin to cry, and invite the old man back to the table.

This tale reminds us of our interdependencies and need for intergenerational solidarity. It is an appropriate starting point for considering our roles in what has been a bruising year for older people. Although more than 95 per cent of older people live in the community, up to one-third of us will spend time in a nursing home before we die. So, ironically juxtaposed with Positive Ageing Week, and the closing of submissions for a national Positive Ageing Strategy, the announcement of the “Fair Deal” is a marker of our identification with our common fate of ageing.

Following the nursing home charges scandal, the Supreme Court ruled in February 2005 that older people who needed nursing home care were eligible to a publicly funded place at a cost of 80 per cent of the non-contributory pension.

The single greatest source of suffering to older people and their families has arisen from a widespread failure to inform them of this eligibility. This has led them to unwittingly spend large sums of money, raise second mortgages, sometimes with an insufficient subvention and often none, and suffer considerable hardship to raise money for care to which they had an eligibility. Older people and their families are probably about the least likely grouping to mount a collective response. There is now a sufficient number of those so affected that to them the Fair Deal appears a positive development, a form of collective Hobson’s choice.

In isolation, this change in eligibility would be troubling: allied to the removal of eligibility to the over-70s medical card, the removal of community rating on private health insurance, the charging for Health Information and Equality Authority (Hiqa) registration of nursing home residents (a charge that clearly would not fly in the intellectual disability setting), we can discern a progressive erosion of intergenerational solidarity.

The removal of these eligibilities, and addition of financial burdens, ahead of the deliberations of the Government group reviewing all eligibility, means, in effect, that we have allowed older people to become the stalking horse for wider changes in eligibility. Not only have we added to our own future burden when we will be older and ill, but we have set precedents for the removal of other eligibilities – a space worth watching.

But it is not just our financial access that matters. Your and my healthcare needs will be greatest from 65 onwards: do we, the public, also care about ensuring a system that incorporates the relevant expertise? If the Government was contracting for cancer services, public opinion would be upset where this was done without involving specialist cancer knowledge. It is not clear that we would be equally upset that contracting for older peoples’ nursing home care was done without a similar clarity.

This is immediately relevant as the State is directly contracting for nursing home beds through the National Treatment Purchase Fund and the Health Service Executive. Will our politicians, and us the electorate, ask that they recognise the lessons of the Leas Cross review, which pointed to an unpreparedness of the Irish health system for complexities of care for this frail and vulnerable group? Will this process include gerontological expertise? Will it try to strip this funding as near as it can to the residential elements of care, or will it effectively match the Leas Cross recommendations and the Hiqa standards, and factor in co-ordinated care, increased gerontological nursing, aids and appliances and other supports required for this group?

Developing an identification with ageing as a common fate is our only hope of turning a fairytale to reality.

Desmond O’Neill is professor of medical gerontology in Trinity College Dublin. He conducted a review of deaths at the Leas Cross nursing home between 2002-2005 which concluded there had been “systematic abuse”.